Thursday, August 2, 2001
House approves amendments that tilt bill against patients, in favor of HMOs
WASHINGTON, D.C. — Consumers Union expressed disappointment this evening after the U.S. House of Representatives approved a bill that supporters touted as patient protection legislation, but, in CU’s view, fails to adequately protect patients in health maintenance organizations (HMOs) and other health plans.
Consumers Union supported the bipartisan bill sponsored by Reps. Greg Ganske and John Dingell in its original form. That bill represented a hard-fought compromise. Unfortunately, the House chose to add amendments that tilted the bill against patients and in favor of HMOs. We hope that the final version of the bill will contain the stronger patient protections approved by the Senate, not the weaker measures and unnecessary provisions in the House legislation.
For example, the House bill contains the Norwood amendment, which makes it nearly impossible for patients to get a full review of their complaints in court. Under the original bill, consumers take their grievances to an outside reviewer. If the reviewer sides with the HMO, consumers have the option of taking the complaint to court. But the Norwood amendment says if the external reviewer sides with the HMO, patients cannot get full review by a court unless they produce “clear and convincing evidence” of the HMO’s wrongdoing. This standard is currently used only in extraordinary circumstances, and is much higher than the usual “preponderance of the evidence” (“more likely than not”) standard for prevailing in a civil case in court. This advantage is granted to HMOs but denied to patients. Under the Norwood amendment, patients who win their external appeal do not get the same presumption in their favor when they go to court.
This presumption in the Norwood amendment makes the external appeals process all the more critical, since the process is the gatekeeper for consumers’ access to full review by a court. Yet the Norwood amendment also weakens the external review process. It ties the reviewer’s hands. Under the Norwood amendment, a reviewer can only uphold or reverse the HMO’s decision, but cannot make even the smallest modification or adjustment. Reviewers who believe the best solution is somewhere in the middle cannot choose that option, and may on a very “close call” be forced to rule in favor of the HMO.
The House also approved an amendment providing for Medical Savings Accounts and Association Health Plans. MSAs siphon off healthier, wealthier people into high-deductible plans, driving up premiums for less healthy people and eroding traditional low-deductible coverage. AHPs would lead to skimpy coverage for some consumers, by waiving state benefit mandates; drive up premiums for the sick; and undermine state efforts to spread health costs fairly across the population.
Consumers Union will continue to work with lawmakers in pursuit of a real patients’ bill of rights that provides long-overdue protections for consumers abused by the managed care system.
Consumers Union, publisher of Consumer Reports magazine, is an independent nonprofit testing, educational and information organization serving only the consumer. We are a comprehensive source of unbiased advice about products and services, personal finance, health, nutrition and other consumer concerns. Since 1936, our mission has been to test products, inform the public and protect consumers.